Validation of iCare IC200 tonometry during natural sleep in children under 3 years with glaucoma: reducing anesthesia dependence in clinical monitoring

YÜKSEL ELGİN C., Atseven A. F., GÜNGÖR G., OCAKOĞLU Ö.

BMC OPHTHALMOLOGY, vol.26, no.1, 2025 (SCI-Expanded, Scopus) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 26 Issue: 1
  • Publication Date: 2025
  • Doi Number: 10.1186/s12886-025-04549-z
  • Journal Name: BMC OPHTHALMOLOGY
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, MEDLINE, Directory of Open Access Journals
  • Istanbul University Affiliated: No

Abstract

BackgroundTo assess the agreement between intraocular pressure (IOP) measurements obtained with the iCare IC200 rebound tonometer during natural sleep and under general anesthesia (EUA) in children under 3 years of age with glaucoma, and to evaluate the impact of this approach on clinical follow-up frequency and anesthesia exposure. MethodsThis prospective study included 74 eye-session pairs from 74 eyes of 27 patients aged 0-36 months diagnosed with pediatric glaucoma. IOP was measured during natural sleep within <= 2 h prior to EUA under end-tidal sevoflurane 2-3%. Measurements were performed by the same examiner under both conditions. Office and EUA frequencies were compared to a historical cohort (2009-2012) to evaluate changes in clinical monitoring trends. ResultsMean age was 18.07 +/- 13.97 months; 78% had primary congenital glaucoma. Natural sleep IOP (21.01 +/- 11.77 mmHg) was consistently higher than EUA IOP (17.69 +/- 9.85 mmHg), with mean difference of 3.32 +/- 3.83 mmHg (14.96 +/- 16.60%) (p < 0.05). A very strong correlation was observed between the two measurement conditions (r = 0.95, R-2 = 0.91). Current surveillance demonstrated 4.45 +/- 2.70 EUA procedures versus 3.18 +/- 2.44 office visits per patient, compared to pre-iCare era ratio of 7.39 +/- 2.65 EUA versus 0.80 +/- 0.70 office visits, representing a 40% reduction in anesthesia dependence. ConclusionNatural-sleep rebound tonometry supports bias-aware, clinic-based trend monitoring and can reduce anesthesia exposure in children under 3 years.